How an umbilical hernia is repaired

Today I did surgery on a cat with a very large umbilical hernia.  I thought it was the perfect opportunity to take pictures and share with you exactly how a hernia is repaired.  The surgery would be exactly the same if this was a dog.

What is an umbilical hernia?

Some animals can be born with a small hole present on their body wall where the umbilicus (belly button) is.  This is always a genetic issue. (Many breeders will claim that the hole was made by the mom chewing too vigorously on the umbilical cord, but this is not true.) In most cases, the hole is very small.  Often it is so tiny that just a small amount of fat can poke out.  The fat is covered by skin and looks like an “outie” belly button.  But, sometimes, such as with this kitty, the hole is much larger.  This poor girl had a hole the size of a plum.  It was so large that her intestines were able to get into the hole.  This meant that the only thing between her hanging intestines and the outside world was a thin layer of skin.

Animals like this need to have their hernia repaired as soon as possible!  For animals with small hernias, it is still recommended to repair them, but we can often wait until it is time to perform their spay or neuter.

Here is a picture of the hernia on this cat with her belly shared as we started to prepare for surgery.  (Her head is to the right of the picture and she is lying on her back):

The surgery:

We prepared her for surgery and moved her into the surgical suite.  I gently made an incision over the hernia.  I had to be very careful, because there was no body wall underneath.  If I was too rough I would have cut right into her intestines!  Once I made the incision, here is what I saw:

You can easily see that her intestines were very vulnerable!

The edges of the hernia were covered in fat.  The fat was adhesed to the lining of the hole.  (Adhesed means that it was basically glued on to the body wall.)  I found some very interesting adhesions.  Check out the photo below!  I noticed that there was a large adhesion that was pulling the liver down into the hernia.  As an interesting note, this cat had an elevated ALT level before surgery.  ALT is a liver enzyme and I’m wondering if this adhesion was causing trauma to the liver as gravity would tug on it as it fell down into the hernia. (You can click on the photo to enlarge it.)

I carefully worked to break down the adhesions without doing any damage to the organs.  Next, what I had to do was cut a fresh edge along the edge of the hole.  If you suture the hole without having fresh tissue, it will eventually come apart again.  Here I am cutting the edges of the hernia:

Once the edges are fresh, then the next step is to place some strong stitches.  I used a suture material called 2-0 PDS.  PDS is a suture that takes a long time to dissolve and is very strong.

Once I had the hole closed, then the next step was to stitch the subcutaneous (under the skin) layer and then the skin.  However, because the skin had stretched I had to trim off a good amount of it before closing the incision completely:

Prognosis:

This cat should heal completely and not have any lasting problems because of the hernia.  Occasionally, when there is a large hole, part of the incision can come apart and sometimes multiple surgeries need to be done.